What is the RUC and Why It is Important to You
The American Medical Association (AMA) convenes an expert panel known as the Relative Value Scale Update Committee or ‘RUC’ to advocate for accurate valuation of all physician services. The RUC is composed of representatives from national medical associations, the AMA, Centers for Medicare and Medicaid Services (CMS), Correct Procedural Coding (CPT), American Osteopathic Association (AOA), and a Health Care Professionals Advisory Committee (HCPAC) representative. The RUC evaluates information presented and makes recommendations to CMS regarding the relative value of physician services and direct practice expenses for new and revised CPT codes. CMS has taken on the responsibility to determine code valuation whether they cover the service or not (e.g., CPT code 76942: Echo guidance for ova aspiration (January 2015 RUC meeting).
ACOG has a seat on the AMA/Specialty Society RUC and actively participates in the process to help determine the physician work associated with each CPT code. As part of the RUC process, you may receive an email from ACOG’s Health Economics Department asking you to participate in a survey to help determine the physician work associated with a CPT code commonly used by obstetrician-gynecologists. By agreeing to participate, you will be acting on behalf of your ob-gyn colleagues in this critical activity and representing your entire specialty.
RUC survey instruments are standardized tools that are used across all specialties. In order to give you some familiarity with the RUC survey instrument and methodology and help you accurately complete a survey, the AMA has put together some informational videos to assist in your understanding of the RUC process and survey instrument.
Understanding the RUC Survey Instrument- Physician Services without a Global Period (XXX-Global): https://www.youtube.com/watch?v=nu5unDX8VIs
Understanding the RUC Survey Instrument- Surgical Services: https://www.youtube.com/watch?v=z1QFGVizeWs
Understanding the RUC Survey Instrument- Non-Physician Qualified Healthcare Professionals: https://www.youtube.com/watch?v=kaw6-OhwbaM
CMS and/or RUC committees regularly identify potentially misvalued codes and request that the specialties who perform those services survey their members to determine the physician work, time, and the intensity/complexity currently involved in performing each service. CMS believes that the work associated with specific codes may have changed since the CPT codes were new or last valued (e.g., procedures that were valued years ago as inpatient procedures with in-hospital post-op visits may have changed site-of-service to an outpatient procedure with fewer post-op visits). CMS sees cost savings in re-valuing these codes when identified in order to accurately describe the work of physicians.
Some other triggers that would bring a CPT code or CPT code family to the attention of CMS besides a change in the site of service are: codes that have experienced fast growth; codes that are frequently billed together; codes that have not been recently reviewed; codes with high cost supplies; codes with substantial changes in practice expenses, etc.
The RUC Survey Process
- ACOG sends out an email invitation (really a plea) for you to participate. The email contains an embedded link to a RUC survey for a specific procedure or service. If you are a physician who performs that procedure/service, we request/urge you to participate in the survey.
- Surveys should be completed based on your ‘typical’ case – not the hardest/longest nor the easiest/shortest, but rather the patient you see most frequently.
- Survey results are compiled and discussed by ACOG’s RUC team of physicians which includes sub-specialty representatives. Recommendations are agreed upon to be presented to the RUC at the next meeting.
- ACOG’s RUC Advisor presents the survey results of work, time, intensity/complexity at the RUC meeting for discussion across all specialties at the AMA/Specialty Society RUC meeting.
- The RUC reviews and discusses the survey results of physician work and ACOG’s recommendations and determines relative value unit (RVU) and practice expense (PE) recommendations to make to CMS.
- CMS either accepts the RUC’s recommendations or amends the recommendations and values the procedure(s) based on their own internal discussions. CMS publishes their approved values in the proposed Medicare Physician Fee Schedule (published annually in July) and solicits comments. Final values are published in the Final Medicare Physician Fee Schedule Rule in November of each year.